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MYELOGRAPHY

The radiographic demonstration of the


structures within the spinal canal by
introducing contrast media into the
subarachnoid space.

MYELOGRAPHY
Anatomic Considerations
Spinal Cord
Part of central nervous system
Two layers
– Inner layer - gray cellular substance (gray matter)
– Outer layer - white fibrous substance (white matter)
Extends from foramen magnum to L1-L2 inner-
space
Conus medullaris is a conical shaped extension
of spinal cord

MYELOGRAPHY
Anatomic Considerations
Spinal Cord (continued)
Filum terminale
– Slender, thread-like prolongation of the conus that
attaches spinal cord to coccyx
– Extension of pia mater
that penetrates dural
sac, where both attach
to coccygeal ligament
MYELOGRAPHY
Anatomic Considerations
Spinal Cord Coverings - three continuous,
protective membranes (meninges)
Pia mater (little mother)
– Inner-most layer
– Adheres closely
to spinal cord
– Highly vascular

MYELOGRAPHY
Anatomic Considerations
Spinal Cord Coverings (continued)
Arachnoid (spider-like)
– Web-like tissue matrix
– Separated from pia mater by subarachnoid space
• Fairly wide space with even wider spaces called
cisternae, widest of which is the cisternae magna
• Connects with the ventricular system of brain by
way of Foramen of Magendie
• Contains cerebrospinal fluid

MYELOGRAPHY
Anatomic Considerations
Spinal Cord Coverings (continued)
Dura mater (tough mother)
– Strong, fibrous tissue
– Separated from arachnoid by subdural space - contains
lubricating fluid (not CSF)
– Epidural space separates dural mater from vertebral
periosteum
• Fat
• Interconnecting arteries, veins, & nerves supplying
the meninges & ligaments
– Extends to the 2nd sacral segment
– Lumbosacral segments are referred to as the dural sac
MYELOGRAPHY
Indications & Contraindications
Indications
Spinal cord tumors – identified
by location
– Extradural
• Cervical spondylosis

• Spinal tuberculosis

• Herniated nucleus pulposus

• Metastatic tumors

– Intradural (subarachnoid space)


• Neurofibromas

• Meningiomas

MYELOGRAPHY
Indications & Contraindications
Indications
Spinal cord tumors (continued)
– Intramedullary (within spinal cord)
• Ependymomas

• Astrocytomas

• Syringomyeloma

Cysts
Arachnoiditis
Spinal nerve root injury
Tumors in the posterior fossa of the skull

MYELOGRAPHY
Indications & Contraindications
Contraindications
Increased intracranial pressure
Intracranial disease
Infection at the puncture site
Coagulopathy
MYELOGRAPHY
The Procedure
Contrast Media
Water-soluble, non-ionic, injectible (Isovue,
Omnipaque) - contrast media of choice.
Oily (Pantopaque) - must be removed after
study.
Negative (Air, Oxygen) - readily absorbed
Pre-procedure care - keep patient well
hydrated to minimize headaches

MYELOGRAPHY
The Procedure
Equipment
Table with full-floating top, tilt, foot board, &
shoulder braces
Overhead tube permitting cross-table filming
Image intensified fluoro tower with
myelographic stop - remove lead curtain from
fluoro tower
Photo-spot camera loaded with film
Cassettes for fluoro spots &/or overheads
Lumbar puncture tray

MYELOGRAPHY
The Procedure
The Puncture
Lumbar puncture
Cisternal puncture
Sacral Hiatus puncture
CERVICAL MYELOGRAPHY
Patient Positioning
Cross-table Lateral

CERVICAL MYELOGRAPHY
Patient Positioning
Swimmer’s

THORACIC MYELOGRAPHY
Patient Positioning
Cross-table Lateral
THORACIC MYELOGRAPHY
Patient Positioning
Cross-table Obliques

THORACIC MYELOGRAPHY
Patient Positioning
Lateral Decubitus (cross-table PA)
PA

LUMBAR MYELOGRAPHY
Patient Positioning
LUMBAR MYELOGRAPHY
Patient Positioning
Cross-table Lateral (10 x 12)

LUMBAR MYELOGRAPHY
Patient Positioning
Cross-table Obliques (10 X 12)

LUMBAR MYELOGRAPHY
Patient Positioning
Lateral Decubitus (cross-table PA) (14 x 17)
PA (11 x 14)